Blog 10

Problem definition: There's a higher prevalence of preterm births in the USA among pregnant women who smoke.

Implementations and Interventions: Tobacco usage while pregnant and reducing preterm birth.

The purpose of implementing programs or policies is to execute a model for those pregnant women or mothers with the issue of tobacco usage as well as other stakeholders such as prenatal care services and any member in the community. For these implementations to work, it should be focused into those key determinants that were looked into and to the stakeholders as well.

Our main stakeholder is the pregnant woman with the issue of their behavior and the services that are provided:

·      Screening to all pregnant women for tobacco use and all receive best practice cessation counseling

This is a policy that should be implemented to all those pregnant women’s or every woman in their communities should be reinforced to go. Tobacco usage in general is already bad and screening could prevent it to these women and to orient them. Also if a women doesn’t smoke and she has high levels of cotinine it is highly due to second hand smoking. This could be caused by one of the determinants, environmental, such as her workplace or even a member in the household which could be even prevented and leading to another implementing program which is:

·      Education programs for women/partners as well as health and social services providers.

As well as prenatal care services will be held, a short term outcome of the program will be that since these workers know the sighs and symptoms of preterm labors an the appropriate response they can share the guidelines and labor assessment if the screening doesn’t look good before the 22 weeks pregnancy.

The Strategy of these two programs combined:

·      Once the screening is done between the 18 and 22 prenatal weeks, due to their results of the cotinine levels prenatal class instructions and as well education through community groups for pregnant women such as Canada Prenatal Nutrition Program (CPNP), which is already implemented, and it is already taken place.

·      Another strategy that is used for these women to be aware off.  CDC also helps states and other groups estimate the costs associated with maternal smoking through its development and promotion of Maternal and Child Health Smoking Attributable Mortality, Morbidity and Economic Costs (MCH SAMMEC) software. MCH SAMMEC is an online application that allows the user to estimate the number of smoking- attributable deaths and years of potential life lost for infants in the United States, as well as neonatal medical expenditures for certain user-defined populations.

o   These results will impact these women how the medical cost is so big and the death poll.

·      A group called National Partnership to Help Pregnant Smokers Quit aims to improve the understanding of how to intervene the best practice and postpartum smokers; develop and evaluate more powerful interventions and strengthen the nation and state based surveillance programs.

o   They’ve also provided a data book to be used for each state:

§  Prevalence of smoking during pregnancy by the mother’s ethnicity, age, and education, and the infant’s birth weight;

§   Smoking-attributable infant deaths due to SIDS;

§  Neonatal illness and health care costs attributable to smoking.

§  Summary birth statistics; • Medicaid programs for pregnant women;

§  Federal/state grant programs to reduce smoking-related adverse outcomes during pregnancy;

§  State cigarette tax and regulatory policies;

§  Maternal and Child Health smoking-cessation programs.

Another intervention:

Preterm Action group, which will include individuals and organizations.

·      Choose priority areas for action and objectives.

·      Get resources and funding and while the plan is in action collect data.

This action group will provide advice and endorsement and to implement the initiative. It is a great place to network with other women who are also going through the same path as they are. This intervention will definitely go towards those that have low income and they have a lack of education such as handling preterm births or even avoiding. This is a great way to bring a Guest Speakers and women who have gone through it or even prenatal care workers that could help those in need.

Based on these interventions we can classify them as which are the ones that it should be tackled first, meaning which is primary (low) secondary (medium) and tertiary (high):

1)    The first intervention or a primary intervention will be posting billboards, media or flyers that will show the communities that involve women who are smokers pregnant or not pregnant to stop smoking. 

2)   The screening should be a secondary prevention. Due to the data collected based on these screenings you can definitely tell what are the progress or the steps that should be taken to make this better or to prevent any risks. As well as to see what are the risks that they are involved as well as avoiding some before having the baby. 

3)    Our tertiary intervention are the educational programs for those smokers/partners that need help and be educated on the second hand smoking (environment determinant) and how to reach to prenatal care services that are available. Preterm Action group is as well a tertiary intervention meaning that is medium. To be able to prevent or reduce the amount of preterm births, with the results of the screening and the education that will be given to those pregnant women between the 18 and 22 weeks, it could definitely help these women be prepared for the worst. Also low income women will have accessibility to it since it will be help around the communities that these women live in and will have guest speakers that could help them understand and let them know that help is always around. Also prenatal care services will be held for their preterm action group. Also another way is for those women that already had a preterm birth should be reached out by the prenatal care services and avoid any future problem.